News Terri Schiavo

I just got an email from a former student of mine regarding the plight of a disabled Florida woman, and it made me really mad. I am wondering if anyone else has heard this story, and if it is as he says.

Here is an excerpt from the email.

Terri Schiavo collapsed more than 12 years ago and has suffered brain damage. I have not found out the specifics on what originally happenned.

Today she is 5 days from having her feeding tube removed and being forced to starve to death. In America you can't starve a mass murderer on death row. You can not starve a dog. But the Florida courts say that if you are the legal guardian of your wife, who is responsive to others, can breathe on her own, is on NO medical life support equipment buat ARE and inconvenience, you can be starved to death.

Here is a list of facts about the case from the American Center for Law and Justice (aclj.org):

There are some very important facts about the case of Terri Schiavo case that cannot be ignored:

This is not a "right to die" case. Rather, this case is about efforts to protect a vulnerable, disabled young woman from being put to death by starvation.

Terri Schiavo is not in a "persistent vegetative state." Terri’s condition is neither terminal nor untreatable; rather, she could benefit from therapy and regain some or all of the functions she has lost.

Terri is aware of her surroundings and is able to communicate; with therapy,

Terri might regain some or all of her speech skills.

Terri did not and does not want to die, especially by starvation and dehydration.

Michael Schiavo, Terri’s legal husband and guardian, is living with another woman who has borne him two children. He wants Terri to die so he can marry this other woman without divorcing Terri.

Michael Schiavo refuses to divorce Terri because to do so would cut off his
inheritance of what remains of her assets.

Michael does not have Terri’s best interests at heart.

Michael Schiavo has refused payments of $1 million and $10 million to keep Terri alive. To paint him and his lawyer in thier own light, his lawyer says to be considered a person you must be able to "eat a ham sandwich", a challenging feat if you have no arms.

This story has been all over the news for a long time now. While there is dispute over what exactly caused the brain damage, some of the events surrounding it were that she had an eating disorder, heart failure, possibly a stroke, and some sequence or combination of those events deprived her brain of oxygen long enough to leave her permanently brain damaged.

All the reports I've seen do indeed report her as being in a persistent vegetative state, with only her parents apparently believing she has any hope of recovery. I have no way to know if she is at all responsive, having only read what is in the news about it.

Her parents claim she would not wish to be taken off life support (a feeding tube in this case), while her husband claims she had indicated to him she would not want to be kept on life support. She had no advanced directives or living will; this case pre-dated the time when people considered such things important.

It is not true her husband is trying to get the feeding tube removed only because he has met someone else he wants to marry and Terri is an inconvenience. This has been a long, drawn out court case, and he met his current significant other after the court battle began, as far as I know.

Could she ever recover? I don't know, though it seems there would be only a very low likelihood of this, especially considering how long she has been in her current state without recovering.

If she had the chance to decide before this happened what should be done, would she want to live or be allowed to die, nobody knows; it is her parents' word against her husband's word.

Is it more humane or less cruel to keep her alive in her condition, or to allow her to dehydrate and starve to death within about a week? That's what most of the public argument is over.

What is the role of the courts in this? That's the question with greatest significance in terms of precedence set for future cases. The courts don't want to decide if she should live or die, they want to only decide who is legally responsible to make that decision on her behalf, but this case is really trying to force them into that decision.

It's a case that is highly charged with ethical, moral and religious feelings and opinions, so I'm trying my best to relay what I've read in the news without arguing my views on this. Though, I will note that I do see validity to both sides of the debate, and only lean toward one side more than other based on my opinions of what my personal wishes would be if I were in such a situation.

Wow. I've actually been following this case for several years. Suffice it to say that this characterization is way off base. Terry Schiavo is in a persistent vegetative state and has been for 12 years. She has been brain dead for that entire time and is not responsive to people (no one but her delusional parents think that she is). Keeping her alive has cost the Florida taxpayers millions of dollars and will continue to cost them that much. The courts have ordered her feeding tube cut off several times only to have Jeb Bush step in on moral grounds (he is opposed to any form of euthunasia) and order that she be kept alive. At this rate, she will live another 50 years, which will cost the state of Florida about $50 million or so, and she will never perform any external function whatsoever nor will she ever have another thought or emotion.

Terry Schiavo is in a persistent vegetative state and has been for 12 years. She has been brain dead for that entire time and is not responsive to people (no one but her delusional parents think that she is).

OK, Googling persistent vegetative state, I find this:

Although people in a persistent vegetative state may make sudden, jerky movements or even open their eyes, evidence suggests that they do not have any awareness of their surroundings and are unable to make any voluntary movements.

Some further information about the distinction between minimally conscious state and vegetative or permanent vegetative state.

2.c. Vegetative state

Patients in a vegetative state are awake but are unaware of themselves or their environment.[*19, *20 ] Jennett and Plum[*19 ] cited the Oxford English Dictionary to explain their choice of the term “vegetative”; to vegetate is to “live merely a physical life devoid of intellectual activity or social intercourse” and vegetative describes “an organic body capable of growth and development but devoid of sensation and thought”. “Persistent vegetative state” has been defined as a vegetative state remaining 1 month after acute traumatic or non-traumatic brain damage.[*21 ] It does not imply irreversibility.[*21 ] “Permanent vegetative state” is irreversible. According to the Multi-Society Task Force on Permanent Vegetative State, vegetative state may be regarded as permanent 3 months after non-traumatic brain damage or 12 months after traumatic injury. These guidelines are best applied to patients who have diffuse traumatic brain injuries and postanoxic events; outcome in other non-traumatic origins may be less well predicted[*22, *23 ] and further consideration of cause and mechanism are needed in prognosis. Even after long and arbitrary delays, some exceptional patients may show limited recovery. This is more likely in patients with non-traumatic coma without cardiac arrest, who survive in vegetative state for more than 3 months. The diagnosis of vegetative state should be questioned when there is any degree of sustained visual pursuit, consistent and reproducible visual fixation, or response to threatening gestures,[*21 ] but these responses are observed in some patients who remain in vegetative state for years. It is essential to establish the formal absence of any sign of conscious perception or deliberate action before making the diagnosis.

2.d. Minimally conscious state

The Aspen group proposed the criteria for minimally conscious state to categorise patients who are not in a vegetative state but are unable to communicate consistently. To be minimally conscious, patients have to show limited but clear evidence of awareness of themself or their environment, on a reproducible or sustained basis, by at least one of the following behaviours: following simple commands, gestural or verbal yes/no response (regardless of accuracy), intelligible speech, purposeful behaviour (including movements or affective behaviour that take place in relation to stimuli in the environment and are not due to reflexive activity). Emergence from the minimally conscious state is defined by the ability to communicate or use objects functionally.[*24 ] Further improvement is more likely than in patients in a vegetative state.[*25 ] However, some people remain in a minimally conscious state permanently. “Akinetic mutism” is a rare state that has been described as a subcategory of the minimally conscious state,[*26 ] but other authors suggest that this term should be avoided.[*27 ]

And the references cited in the above paragraph, in case you're interested in looking further and can't access the article:

(I'm linking to the article through my institutional subscription, so can't provide a link that will work for anyone accessing from somewhere else; if you have access, you can find the link through pubmed for your own institution. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi )

...Terry Schiavo is in a persistent vegetative state and has been for 12 years. She has been brain dead for that entire time...

I have a nit to pick here to keep this factually accurate. A persitent or permanent vegetative state is not synonymous with being brain dead. Brain death is THE established criterion for diagnosing a person as dead. In a vegetative state, there is brainstem function, but no or limited cortical function. In other words, reflexes and arousal (wakefulness) can occur in a vegetative state. In brain death, reflexes will be absent.

I saw those clips years ago, they are the equivalent to me filming my dog and telling him to bark once if the answer to 2+2=4 and bark twice if the answer to 5+5=10, etc...and then claiming he understands. Of course I will cut out the 10,000 times he either doesn't respond or responded incorrectly. If I am not mistaken I believe the reason the judge ruled against the videos is because medical workers taking care of Terri testified that she routinely makes those same motions and facial expressions without prompting or stimulus.

I understand the parent's grief at the loss of their daughter, I can't say how I would act. Would I continue to cling to some false hope, perhaps.

I saw those clips years ago, they are the equivalent to me filming my dog and telling him to bark once if the answer to 2+2=4 and bark twice if the answer to 5+5=10, etc...and then claiming he understands.

Well, first of all, you wouldn't stop feeding your dog just because he can't add, would you?

And second, I'm not saying that she recognizes any of the people around her or even that she comprehends what is being said to her. What I find troubling here is the fact that she may still feel, and be aware that she is feeling.

If I am not mistaken I believe the reason the judge ruled against the videos is because medical workers taking care of Terri testified that she routinely makes those same motions and facial expressions without prompting or stimulus.

When I compared the definition of PVS to those video clips, what struck me is the absence of "sudden, jerky movements".

As I said before, what I'm really interested in here is this: On what basis have the husband and the courts determined that she isn't going to suffer horribly as she starves to death?

When I compared the definition of PVS to those video clips, what struck me is the absence of "sudden, jerky movements".

As I said before, what I'm really interested in here is this: On what basis have the husband and the courts determined that she isn't going to suffer horribly as she starves to death?

As I mentioned, I can't view the video clips, so am limited on what I can say in reference to them. I don't think "sudden, jerky movements" are required for a diagnosis of PVS. On a related note, smiling and crying can be reflexive responses. I can try to dig up references on this if you need it, but even in newborn infants, smiling and crying are considered reflexive behaviors, not deliberate or requiring higher brain function. That's why they tell parents babies aren't "really" smiling as newborns even though most parents will insist they saw their baby smiling at them. I'm not saying babies are in a vegetative state, because that's not true; they are still developing cortical functions and do have cortical activity. The only point I'm trying to make is that smiling and crying do not necessarily require higher brain functions.

Will she suffer? If she is truly in a PVS, she should not. I say "should," not "will" because I really can't be 100% certain that it couldn't happen. However, I think from a suffering standpoint, if she does have feeling right now, then the question remains whether keeping her alive is also causing her pain or suffering.

That's the part I find most troubling in this case; if she really can feel anything, I don't know which is the worse suffering, to allow her to dehydrate and starve (the dehydration will kill her much faster than starvation would; starvation alone could take a very long time), or to keep her alive in her present state, because I have no way to know what she is feeling as long as she cannot communicate.

As I was digging for those articles, it seems there is research in the past few years using fMRI scans that would allow determination if brain areas are active that would allow progression to a minimally conscious state, where it is believed feeling could occur. Those articles are also accompanied by discussion of the ethics of research on patients who are not conscious to give consent. Perhaps it would be in Terri's best interest to do the scan before making a final decision regarding a potentially painful manner of death since the case has dragged on long enough for new technology to be available. Regardless, it sounds like the best they can hope for in terms of recovery is for her to remain in a minimally conscious state.

I'm inclined to believe judges who are professionally trained to consider evidence in making a ruling—especially in regard to someone’s life, which I’m sure is taken very seriously. Therefore, I assume there is no hope of recovery. If this is the case, one must ask about quality of life and whether Terri really wants to go on living in this condition. And if she does not, then the debate becomes one of assisted suicide. In this case, also the method. We do not starve a dog to death, however we do believe it is humane to end an animal’s misery. (As a side note - If Jeb has indeed interfered on a pro-life basis, I'm curious if he is pro-capital punishment like his brother.)

Staff: Mentor

I'm downloading the plugin for that video now, but thinking about being in a coma reminds me of two things:

-what I've heard of sensory deprivation: its a form of torture that quickly breaks those it is used on.

-worse, waking up during surgery. Apparently, some surgeries require multiple anesthesias: one to paralyze and one to knock you out. People have reported waking up during surgery, being unable to tell anyone because they were paralyzed, and feeling everything.

Either of those scenarios would be a living hell for me. That, plus the pain inflicted on my relatives makes me not want to be kept alive if I were in a coma that my doctors said I'd probably never wake up from.

I'm downloading the plugin for that video now, but thinking about being in a coma reminds me of two things:

-what I've heard of sensory deprivation: its a form of torture that quickly breaks those it is used on.

-worse, waking up during surgery. Apparently, some surgeries require multiple anesthesias: one to paralyze and one to knock you out. People have reported waking up during surgery, being unable to tell anyone because they were paralyzed, and feeling everything.

Either of those scenarios would be a living hell for me. That, plus the pain inflicted on my relatives makes me not want to be kept alive if I were in a coma that my doctors said I'd probably never wake up from.

PVS is also not the same as a coma. Aren't you glad to know there are so many different ways to be severely brain-damaged?

There's basically a heirarchy of disorders of awareness and consciousness: brain-dead, coma, persistent vegetative state, vegetative state (duration is what distinguishes a PVS from just a VS), minimally conscious state, locked-in syndrome.

Personally, I find myself agreeing with you in terms of what I would choose for myself. I can't think of much worse of a fate than to be alive but unable to communicate on any level, whether I was able to think and feel or not. I would rather suffer a week dying a painful death than an indefinite number of years trapped inside my own body. But, I also recognize that is a very personal choice, and not one I would hastily choose for another person. I know other people who would never want anyone to give up on them, and to keep them alive at any cost in the hope of a medical miracle.

I have a nit to pick here to keep this factually accurate. A persitent or permanent vegetative state is not synonymous with being brain dead. Brain death is THE established criterion for diagnosing a person as dead. In a vegetative state, there is brainstem function, but no or limited cortical function. In other words, reflexes and arousal (wakefulness) can occur in a vegetative state. In brain death, reflexes will be absent.

Cool. I actually didn't realize that. I thought that the cessation of higher functions still qualified as brain death.

I'm inclined to believe judges who are professionally trained to consider evidence in making a ruling—especially in regard to someone’s life, which I’m sure is taken very seriously. Therefore, I assume there is no hope of recovery. If this is the case, one must ask about quality of life and whether Terri really wants to go on living in this condition. And if she does not, then the debate becomes one of assisted suicide. In this case, also the method. We do not starve a dog to death, however we do believe it is humane to end an animal’s misery. (As a side note - If Jeb has indeed interfered on a pro-life basis, I'm curious if he is pro-capital punishment like his brother.)

The quality of Terry's life is not the only issue here. The other issue, an important issue if you ask me, is the cost of keeping her alive. The monitors, feeding machines, and space that she is using are very expensive and all of her care is being publicly paid for. There is a great furor in this nation over the cost of healthcare, and loads of money being spent to keep vegetables alive that otherwise could not keep themselves alive is not a way to alleviate the problem.

This is also not a case of assisted suicide. Removing the feeding tubes would allow Terry to die the natural death that she otherwise would die. You might argue that it would be more humane (in the slimly possible case that she still experiences sensations of some sort), but as assisted suicide is illegal in this nation, that cannot be done.

Either of those scenarios would be a living hell for me. That, plus the pain inflicted on my relatives makes me not want to be kept alive if I were in a coma that my doctors said I'd probably never wake up from.

Thank you (and Moonbear) for making these points. I have relatives who have suffered from a rare disease that basically results in paralysis (inability to send signals from the brain in order to perform motor skills, including speech, etc.). I have an uncle who was struck with this in his 30's, and unfortunately took his own life. He had become basically bed-ridden and confined to a wheelchair, and he couldn't stand the thought of being a burden to his family. But like Moonbear said (and Evo) these are things individuals have to sort out for themselves.

Cool. I actually didn't realize that. I thought that the cessation of higher functions still qualified as brain death.

No problem. I learned a lot more about the topic tonight myself. I was also rather surprised and dismayed to see PubMed now brings up non-scientific literature when you do a search (it even had something written by Pope John Paul II!!!). I was searching on 'persistent vegetative state' and had to dig through piles of references that were not in scientific journals just to get to the science! :grumpy:

Isn't it better to shoot her with one bullet that let her starve for some days?

Unfortunately, the law doesn't allow for euthanasia. There is a distinction between allowing someone to die and helping them to die.

To me, dying is not an event but a process, like anything else in biology. For some the process occurs quickly, and for others it is more prolonged. In situations such as this one, my personal opinion is that it becomes important to evaluate whether you are prolonging life or prolonging dying. That is something that must be done on an individual basis. It is often much harder to determine what a young person would have wished than an older person. As we age, we think more about "what if" and recognize our mortality, so begin to make our wishes known. When we are young, death isn't really something we think about, as it seems so far away. Very few people would anticipate or plan for something like this happening to someone who is young, so their own wishes are rarely known.

Staff: Mentor

Issues like this make me step back and look for "big picture": This issue is hotly debated and creates a lot of animosity (not just in this thread - the lawsuit is pretty bitter), but consider that 50 years ago (not sure of the real timeline), it wouldn't have even been possible to keep this woman alive more than a few days. The fact that we're even having this discussion reflects some amazing advances in medical science that have (for better or worse) already prolonged this woman's life by 12 years. Whether she lives or dies, I'm greatful that I live in a time where science has enabled such an argument.